Association of markers of systemic and local inflammation with prognosis of patients with rectal cancer who received neoadjuvant radiotherapy

Abstract

PurposeThe inflammatory status of patients with cancer appears to affect cancer progression and patient prognosis. We examined the characteristics of cancer-associated systemic and local inflammation and its impact on the overall survival (OS) of patients with locally advanced rectal cancer (LARC) who received neoadjuvant radiotherapy (nRT).Patients and methodsSeventy-six consecutive LARC patients who received nRT from February 2012 to September 2015 were retrospectively analyzed. The peripheral neutrophil-to-lymphocyte ratio (NLR) was determined at diagnosis, and the CD8+ T-cell count was determined from surgical specimens. Factors associated with OS were identified by univariate and multivariate Cox regression.ResultsThe median follow-up time was 23.0 months (range: 2–59), and the overall 5-year OS rate was 68.6% (95% CI =46.06–91.14). Patients with a high NLR (≥2.0) and a low CD8+ T-cell count (<9%) had a significantly worse 5-year OS than those with a low NLR and a high CD8+ T-cell count (P=0.005). NLR was also associated with lymphovascular invasion (P=0.014) and T stage (P=0.047), and the CD8+ T-cell count was associated with mucinous adenocarcinoma (P=0.005) and T stage (P=0.049). An NLR <2.0 was associated with pathological complete regression after nRT (P=0.039). Multivariate Cox regression indicated that NLR (P=0.025), CD8+ T-cell count (P=0.018), age (P=0.020), lymphovascular invasion (P=0.038), and T stage (P=0.011) were independently associated with OS.ConclusionA high NLR and a low CD8+ T-cell count were significantly associated with poor survival in our population of patients with LARC. Measurement of markers of systemic and local inflammation might help to predict the prognosis of patients with LARC after nRT.

A meta-analysis of the impact of neutrophil-to-lymphocyte ratio on treatment outcomes after radiotherapy for solid tumors

“…Analyses included PFS in 15 studies, [10,17–30] DFS in 11 studies, [16,17,31–37] DMFS in 8 studies, [19,23,27,30,38,39] DSS in 1 study, [23] and pathologic CR in 2 studies on preoperative CCRT. [25,40] The median NLR cut-off value was 3.1 (range 1.9–5.0). ROC curves were used to estimate the optimal NLR cut-off value in 14 studies.…”

<p>Role of the pretreatment neutrophil-to-lymphocyte ratio in the survival of primary parotid cancer patients</p>

“…The NLR was defined as the absolute neutrophil count divided by the absolute lymphocyte count within 2 weeks before the initial treatment. [4][5][6][7][8][9][10][11][12][13][14] The cutoff value calculated from the ROC curve, mean, tertile, or median in previous studies varied from 1.98-5; 4-11 thus, the standard cutoff value remains unknown. In the current study, the cutoff value was defined as the mean value of the NLR.…”

“…[1][2][3] The peripheral neutrophil-to-lymphocyte ratio (NLR) is a well-known inflammatory marker. Several authors have previously reported that a high NLR is significantly associated with poor survival in solid cancers, [4][5][6][7][8][9][10][11][12][13][14] including head and neck squamous cell carcinoma and breast cancer. However, whether the NLR affects prognosis in patients with parotid cancer remains unknown; therefore, the current study aimed to clarify this question.…”

Diagnostic value of platelet‐lymphocyte ratio and hemoglobin‐platelet ratio in patients with rectal cancer

“…Recent studies have shown that markers of systemic inflammation could be useful biomarkers for the diagnosis of many cancers. As far as we know, there were several retrospective analyses that investigated the relationship between PLR, neutrophil‐lymphocyte ratio (NLR), and albumin‐globulin ratio (AGR) in the prognosis of rectal cancer . But rarely have studies assessed the diagnosis role of these hematological parameters in rectal cancer.…”

“…As far as we know, there were several retrospective analyses that investigated the relationship between PLR, neutrophil-lymphocyte ratio (NLR), and albumin-globulin ratio (AGR) in the prognosis of rectal cancer. 11,15,16 But rarely have studies assessed the diagnosis role of these hematological parameters in rectal cancer. Therefore, we intend to investigate the role of PLR, hemoglobin-platelet ratio (HPR), and CEA, which were used alone or in combination, in early screenings and diagnoses of rectal cancer.…”